Births to women enrolled in emergency Medicaid at the time of delivery with prenatal care provided in North Carolina public health departments

State Center for Health Statistics Statistical Brief No. 34 – November 2007
N. C. Department of Health and Human Services 1 Division of Public Health
Births to Women Enrolled in Emergency Medicaid at the Time of Delivery
with Prenatal Care Provided in North Carolina Public Health Departments
by Paul A. Buescher, Ph. D. and
Joseph L. Holliday, M. D., M. P. H.
Statistical Brief No. 34
North Carolina
Department of Health and Human Services
Division of Public Health
State Center for Health Statistics November 2007
Statistical
Brief
www. schs. state. nc. us/ SCHS/
In 1996, national welfare reform reduced immi-grants’
eligibility for publicly funded services such
as Medicaid. Restrictions were placed on using
federal Medicaid funds for some legal immigrants
and for all illegal immigrants except for emer-gency
services. For pregnancy- related services,
Medicaid reimbursement is now provided for de-livery
but not for prenatal care. Additional federal
funds for prenatal care have not been forthcoming
over the past 10 years. Many states, including
North Carolina, have not extended coverage be-yond
federal provisions. 1
Along with the growth of the Hispanic population
in North Carolina, there has been a very large in-crease
in the number of emergency Medicaid
births, defined as births where Medicaid pays for
the delivery but does not pay for prenatal care. For
many of these emergency Medicaid births,
prenatal care is provided in local public health de-partment
maternity clinics with limited reimburse-ment
from Medicaid. This report documents the
increase in emergency Medicaid births in North
Carolina where prenatal care was provided by
public health departments.
While the growth in the number of Hispanic births
has contributed strongly to an increase in the num-ber
of emergency Medicaid births, it should not
be concluded that the large majority of Hispanic
births in North Carolina are emergency Medicaid.
Out of 19,512 Hispanic live births in 2005, 10,134
or 52 percent were emergency Medicaid. These
10,134 Hispanic emergency Medicaid births rep-resented
93 percent of the 10,899 total emergency
Medicaid births in North Carolina in 2005.
Live births where prenatal care was provided in a
local health department increased from approxi-mately
24,000 in 1990 to 26,000 in 2005. Among
these births, the number of emergency Medicaid
births increased from 101 in 1990 to 6,013 in 2005
( see Figure 1), or from less than 1 percent to nearly
one- fourth of all health department births. Of the
6,013 emergency Medicaid births in 2005, 5,612
( 93%) were to Hispanic women, according to the
ethnicity indicator on the birth certificate. In ad-dition
to the 6,013 births paid for by emergency
Medicaid in 2005, there were 16,315 health
department births where Medicaid paid for the de-livery
and prenatal care, and 3,365 births where
Statistical Brief No. 34 – November 2007 State Center for Health Statistics
N. C. Department of Health and Human Services 2 Division of Public Health
Medicaid did not pay for prenatal care or the
delivery.
The counts of emergency Medicaid births shown
in Figure 1 are based on live birth files to which
health department prenatal care records and Medi-caid
delivery records have been matched. The
matching rate is considerably less than 100 percent
using mother’s name and date of birth, especially
for Hispanics. 2 So the actual numbers of emer-gency
Medicaid live births in North Carolina are
higher than those shown in this report.
It is very difficult to translate the number of emer-gency
Medicaid births into a dollar amount of un-compensated
prenatal care provided by North
Carolina public health departments. Though the
prenatal care for these births is generally not cov-ered
by Medicaid, some women who have their
deliveries paid for by emergency Medicaid are
“ presumptively eligible” for the first month or two
of their prenatal care and therefore the health
department would receive some early payments
for prenatal care from Medicaid. In addition, local
health departments receive funds from the
Division of Public Health to pay for some of their
clinical services, including prenatal care, not cov-ered
by Medicaid. Also, local health departments
may charge patients a fee for prenatal care on a
sliding scale.
The numbers of emergency Medicaid births
shown in Figure 1 will be lower than the total
health department emergency Medicaid prenatal
care caseload in the year, since only those patients
delivering in each year are included in Figure 1.
The impact of emergency Medicaid births on
health departments varies considerably. Among
the 2005 deliveries, for 15 health departments
more than 40 percent of the women enrolled in
their prenatal clinic received emergency Medicaid
at delivery. In contrast, for 51 health departments
less than 20 percent of the women enrolled in their
prenatal clinic received emergency Medicaid.
Figure 1: Emergency Medicaid Live Births Where Prenatal Care
Was Received In North Carolina Public Health Departments
1990- 2005
101 172 249 289 416
644
942
1479
1877
2178
3202
4363 4540 4654
5300
6013
0
1000
2000
3000
4000
5000
6000
7000
1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Number
State Center for Health Statistics Statistical Brief No. 34 – November 2007
N. C. Department of Health and Human Services 3 Division of Public Health
In summary, the number of women receiving pre-natal
care in North Carolina local health depart-ments
and enrolled in emergency Medicaid for
delivery is large and increasing. This suggests that
the amount of uncompensated prenatal care pro-vided
by local health departments is also on the
rise. Health departments are not the only provid-ers
in the state who supply prenatal safety net
services. In addition to the 6,013 births paid for
by emergency Medicaid where prenatal care was
provided in local health departments, there were
4,886 other emergency Medicaid births in 2005.
The total of 10,899 emergency Medicaid live
births in North Carolina in 2005 represents
8.9 percent of all live births in the state.
Acknowledgments:
Kathleen Jones- Vessey and Tim Whitmire of
the State Center for Health Statistics
produced the data used in this report.
Leslie Brown of the Office of Minority Health and
Health Disparities and Annette Dubard of the
Division of Medical Assistance provided
valuable suggestions for improvement.
References
1. Dubard CA, Massing MW. Trends in emergency
Medicaid expenditures for recent and undocu-mented
immigrants. JAMA. 2007; 297:
1085- 1092.
2. Patel KV, Eschbach K, Ray LA, Markides KS.
Evaluation of mortality data for older Mexican
Americans: implications for the Hispanic para-dox.
American Journal of Epidemiology.
2004; 159: 707- 715.
Statistical Brief No. 34 – November 2007 State Center for Health Statistics
N. C. Department of Health and Human Services 4 Division of Public Health
Printed on recycled paper
450 copies of this public document were printed
at a cost of $ 75.78 or 17¢ per copy. 11/ 07
State of North Carolina
Michael F. Easley, Governor
Department of Health and Human Services
Dempsey Benton, Secretary
Division of Public Health
Leah Devlin, DDS, Director
Chronic Disease and Injury Section
Marcus Plescia, MD, MPH, Section Chief
State Center for Health Statistics
Paul A. Buescher, PhD, Director
www. ncdhhs. gov
N. C. DHHS is an equal opportunity employer and provider.
Department of Health and Human Services
State Center for Health Statistics
1908 Mail Service Center
Raleigh, NC 27699- 1908
( 919) 733- 4728
For more information about this
publication, contact:
Paul Buescher at ( 919) 715- 4478
e- mail: Paul. Buescher@ ncmail. net
For a list of other publications by the
State Center for Health Statistics call:
( 919) 733- 4728
or check the website at:
www. schs. state. nc. us/ SCHS/

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State Center for Health Statistics Statistical Brief No. 34 – November 2007
N. C. Department of Health and Human Services 1 Division of Public Health
Births to Women Enrolled in Emergency Medicaid at the Time of Delivery
with Prenatal Care Provided in North Carolina Public Health Departments
by Paul A. Buescher, Ph. D. and
Joseph L. Holliday, M. D., M. P. H.
Statistical Brief No. 34
North Carolina
Department of Health and Human Services
Division of Public Health
State Center for Health Statistics November 2007
Statistical
Brief
www. schs. state. nc. us/ SCHS/
In 1996, national welfare reform reduced immi-grants’
eligibility for publicly funded services such
as Medicaid. Restrictions were placed on using
federal Medicaid funds for some legal immigrants
and for all illegal immigrants except for emer-gency
services. For pregnancy- related services,
Medicaid reimbursement is now provided for de-livery
but not for prenatal care. Additional federal
funds for prenatal care have not been forthcoming
over the past 10 years. Many states, including
North Carolina, have not extended coverage be-yond
federal provisions. 1
Along with the growth of the Hispanic population
in North Carolina, there has been a very large in-crease
in the number of emergency Medicaid
births, defined as births where Medicaid pays for
the delivery but does not pay for prenatal care. For
many of these emergency Medicaid births,
prenatal care is provided in local public health de-partment
maternity clinics with limited reimburse-ment
from Medicaid. This report documents the
increase in emergency Medicaid births in North
Carolina where prenatal care was provided by
public health departments.
While the growth in the number of Hispanic births
has contributed strongly to an increase in the num-ber
of emergency Medicaid births, it should not
be concluded that the large majority of Hispanic
births in North Carolina are emergency Medicaid.
Out of 19,512 Hispanic live births in 2005, 10,134
or 52 percent were emergency Medicaid. These
10,134 Hispanic emergency Medicaid births rep-resented
93 percent of the 10,899 total emergency
Medicaid births in North Carolina in 2005.
Live births where prenatal care was provided in a
local health department increased from approxi-mately
24,000 in 1990 to 26,000 in 2005. Among
these births, the number of emergency Medicaid
births increased from 101 in 1990 to 6,013 in 2005
( see Figure 1), or from less than 1 percent to nearly
one- fourth of all health department births. Of the
6,013 emergency Medicaid births in 2005, 5,612
( 93%) were to Hispanic women, according to the
ethnicity indicator on the birth certificate. In ad-dition
to the 6,013 births paid for by emergency
Medicaid in 2005, there were 16,315 health
department births where Medicaid paid for the de-livery
and prenatal care, and 3,365 births where
Statistical Brief No. 34 – November 2007 State Center for Health Statistics
N. C. Department of Health and Human Services 2 Division of Public Health
Medicaid did not pay for prenatal care or the
delivery.
The counts of emergency Medicaid births shown
in Figure 1 are based on live birth files to which
health department prenatal care records and Medi-caid
delivery records have been matched. The
matching rate is considerably less than 100 percent
using mother’s name and date of birth, especially
for Hispanics. 2 So the actual numbers of emer-gency
Medicaid live births in North Carolina are
higher than those shown in this report.
It is very difficult to translate the number of emer-gency
Medicaid births into a dollar amount of un-compensated
prenatal care provided by North
Carolina public health departments. Though the
prenatal care for these births is generally not cov-ered
by Medicaid, some women who have their
deliveries paid for by emergency Medicaid are
“ presumptively eligible” for the first month or two
of their prenatal care and therefore the health
department would receive some early payments
for prenatal care from Medicaid. In addition, local
health departments receive funds from the
Division of Public Health to pay for some of their
clinical services, including prenatal care, not cov-ered
by Medicaid. Also, local health departments
may charge patients a fee for prenatal care on a
sliding scale.
The numbers of emergency Medicaid births
shown in Figure 1 will be lower than the total
health department emergency Medicaid prenatal
care caseload in the year, since only those patients
delivering in each year are included in Figure 1.
The impact of emergency Medicaid births on
health departments varies considerably. Among
the 2005 deliveries, for 15 health departments
more than 40 percent of the women enrolled in
their prenatal clinic received emergency Medicaid
at delivery. In contrast, for 51 health departments
less than 20 percent of the women enrolled in their
prenatal clinic received emergency Medicaid.
Figure 1: Emergency Medicaid Live Births Where Prenatal Care
Was Received In North Carolina Public Health Departments
1990- 2005
101 172 249 289 416
644
942
1479
1877
2178
3202
4363 4540 4654
5300
6013
0
1000
2000
3000
4000
5000
6000
7000
1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Number
State Center for Health Statistics Statistical Brief No. 34 – November 2007
N. C. Department of Health and Human Services 3 Division of Public Health
In summary, the number of women receiving pre-natal
care in North Carolina local health depart-ments
and enrolled in emergency Medicaid for
delivery is large and increasing. This suggests that
the amount of uncompensated prenatal care pro-vided
by local health departments is also on the
rise. Health departments are not the only provid-ers
in the state who supply prenatal safety net
services. In addition to the 6,013 births paid for
by emergency Medicaid where prenatal care was
provided in local health departments, there were
4,886 other emergency Medicaid births in 2005.
The total of 10,899 emergency Medicaid live
births in North Carolina in 2005 represents
8.9 percent of all live births in the state.
Acknowledgments:
Kathleen Jones- Vessey and Tim Whitmire of
the State Center for Health Statistics
produced the data used in this report.
Leslie Brown of the Office of Minority Health and
Health Disparities and Annette Dubard of the
Division of Medical Assistance provided
valuable suggestions for improvement.
References
1. Dubard CA, Massing MW. Trends in emergency
Medicaid expenditures for recent and undocu-mented
immigrants. JAMA. 2007; 297:
1085- 1092.
2. Patel KV, Eschbach K, Ray LA, Markides KS.
Evaluation of mortality data for older Mexican
Americans: implications for the Hispanic para-dox.
American Journal of Epidemiology.
2004; 159: 707- 715.
Statistical Brief No. 34 – November 2007 State Center for Health Statistics
N. C. Department of Health and Human Services 4 Division of Public Health
Printed on recycled paper
450 copies of this public document were printed
at a cost of $ 75.78 or 17¢ per copy. 11/ 07
State of North Carolina
Michael F. Easley, Governor
Department of Health and Human Services
Dempsey Benton, Secretary
Division of Public Health
Leah Devlin, DDS, Director
Chronic Disease and Injury Section
Marcus Plescia, MD, MPH, Section Chief
State Center for Health Statistics
Paul A. Buescher, PhD, Director
www. ncdhhs. gov
N. C. DHHS is an equal opportunity employer and provider.
Department of Health and Human Services
State Center for Health Statistics
1908 Mail Service Center
Raleigh, NC 27699- 1908
( 919) 733- 4728
For more information about this
publication, contact:
Paul Buescher at ( 919) 715- 4478
e- mail: Paul. Buescher@ ncmail. net
For a list of other publications by the
State Center for Health Statistics call:
( 919) 733- 4728
or check the website at:
www. schs. state. nc. us/ SCHS/